It has often
been found that many children with mental health problems do not
receive professional help for them. The reasons may include unavailability
of services, financial obstacles, parents' lack of awareness or
motivation, lack of appropriate referral pathways, and use of
alternative kinds of help. In the Netherlands and several other
countries, general practice physicians are expected to provide
initial evaluations of children's mental health problems. If necessary,
the physicians then refer the children to mental health services,
which have no financial barriers to care. To identify the actual
pathways for help-seeking in this type of system, a team of Dutch
researchers assessed the mental health problems of 1,319 4- to
11-year-old participants in the Dutch National Survey of General
Practice (Zwaanswik et al., 2005). The children's parents completed
the CBCL and their teachers completed the TRF. A structured diagnostic
interview (the DISC-IV) was administered to parents of children
whose Total Problems scores were in the borderline or clinical
range (T scores >60) on the CBCL or TRF. The parents were also
asked about their efforts to seek help for the children's problems
during the preceding 12 months. Help was sought from friends or
relatives for 48% of the children who were considered to need
professional mental health services because they qualified for
diagnoses and met impairment criteria. For 52% of the children,
help was sought from teachers. Help was sought from general practitioners
for only 27%. (The percentages exceed 100% because help was sought
from more than one source in some cases.) For the children who
ultimately received professional mental health services, 43% were
referred by general practitioners, whereas 57% did not come through
general practitioners. The general practitioners thus provided
help for only a minority of children who were judged to need services
and were the referral agents for only a minority of those who
ultimately received professional mental health services. Although
some family characteristics were associated with help seeking,
the strongest predictors of help seeking were the CBCL and TRF
ratings. The authors concluded that access to mental health care
could be enhanced by educating parents about child psychopathology
and about care, improving general practitioners' skills in detecting
child psychopathology, and promoting direct contact of mental
professionals with general practitioners and schools.